1. Field of the Invention
The present invention relates to a new and improved surgical needle. More specifically, it relates to an inexpensive, simply designed sickle shaped needle having a short shank utilized to rapidly close deeply lying trocared fascial wounds after laparascopic surgery. An optional modified needle holder is also disclosed.
2. Description of the Prior Art
A variety of surgical needles have been proposed in the past. Typically, prior needles have been formed of wire into a circular arc ranging from 1/4 to 2/3 of a circle and having a sharpened point or edge for cutting. A variety of specialized needles utilized for a particular purpose have been proposed in a variety of other shapes. Examples of such needles are described below.
In R. J. Barry, U.S. Pat. No. 3,608,095, a needle is disclosed for use on the surface of the head for hair transplants. The needle has a curved or hook-like pointed terminal 21 adapted to penetrate the scalp and a long shank portion 20 to which a Teflon tube attachment 22 is provided. Because of the long shank, it would be completely impossible to suture deeply located fascial closures which are located below the subcutaneous fatty layer with such a needle. Further, the size and shape of the needle will not fit through the small laparascopic puncture wound into the abdomen.
In L. D. Kurtz et al, U.S. Pat. No. 2,811,157, a needle is shown in the drawings which bears a superficial resemblance to the shape of the needle of the present invention. The shape of the needle is described merely as being of the well-known variety and may be straight or curved with the suture fixed within the end of the needle. The needle has a cutting edge designed to penetrate the tissue easily and may have a non-cutting portion used for more delicate tissue. The invention is mainly used for minimal traumatic surgeries. It could not, however, be effectively used to suture deeply located fascia below the subcutaneous fatty layer through a 10 mm. trocared opening in the abdominal wall because of the shape disclosed would result in an increased risk that the point of the needle would puncture tissue during insertion.
In J. R. Scott, U.S. Pat. No. 2,811,971, multiple needles are hooked to the skin, opposite one another to close a wound at the surface of the skin. Each needle has a handle which is taped fast to the skin. The needles are left in place until the wound is healed. Because such needles have long handle style shanks, they would be completely unsuitable for suturing fascia which is located below the subcutaneous fatty layer. The goose neck of the needle and the long handle would clearly prevent rotation of the needle and removal from the fascia.
In Shah, U.S. Pat. No. 5,059,207, a variety of V and U shape needles are disclosed. Because of their shape, it would be extremely difficult to rotate needles out of one end of the skin to the opposite side of the skin end and would be especially difficult to suture multiple layers at one time.
These needles use a blind approach and there is a significant risk involved of inadvertently catching and puncturing the bowels, stomach, omentum, or internal organs. Although a blunt probe is used, there is still risk involved with the process disclosed because of the uncertainty of the depth of needle penetration and length of needles on different thicknesses of each individual abdominal wall, especially on the obese patient. Further, it is difficult to pass the needle and rotate it to bring it out of the skin using the V or U shape needles on different thicknesses of the abdominal wall at one time. Therefore, this invention's range of skin entrance by needle on either side is 1.0 cm. to 5 cm. of distance depending on the abdominal wall thickness of the tissue. This is a tremendous distance on a skin puncture and suggests that some rotating difficulty of the needle may be encountered on the overweight patient.
Still further, when suturing multiple layers of the abdominal wall, the skin can become inverted and wrinkled. Also, a great amount of pressure is exerted on the skin surface from the tied knots which prevent separation of the deep layers. Sutures must remain in place to heal deep layer of the fascia, at least three weeks. During this time, undesirable scar formation may occur at the knot area and puncture site.
Laparascopic surgery usually involves four puncture wounds in the abdominal wall. Using Shah's needle would create even more puncture wounds resulting in needless undesirable scar formation. Most laparascopic surgeons utilize subdermal dissolving skin sutures for cosmetic reasons.
In McGregor et al, U.S. Pat. No. 4,524,771, a needle is disclosed strictly for corneal transplants of the eye under a microscope. It has a sharp, hook-type tip and a tapered shaft to pick up small bits of delicate eye tissue. The needle is fine and small and is used for surface work; not heavy tissue in the deep abdominal wall.
The needle has a fish-hook type needle with a mildly curved end. The radius of curvature is from 0.040 inches to 0.075. The length curvature is from 0.063 inches to 0.105 inches. The blunt end of the needle has a radius of curvature from 0.081 inches to 0.015 inches. It has a gentle curvature and can therefore smoothly penetrate delicate tissue by circular motion for surface work. This fish-hook type needle clearly does not have sufficient curvature and does not have a heavy enough gauge needle to suture deeply located fascia in the abdominal wall through a 10 mm. puncture wound; especially on the overweight patient. This type of needle would likely break if it were to be used to encircle heavy tissue. Still further, the curved end of the needle makes it difficult to grasp and stabilize the needle while suturing deep tissue, unless surface work is being sutured.
Thus, there remains a need for an inexpensive and effective surgical needle which may be utilized to rapidly close deeply lying trocared fascial wounds after laparascopic surgery.